Transcendental Meditation for treating PTSD

A new article in Military Medicine (Jan 2016) details research performed by military medical personnel at Dwight David Eisenhower Army Medical Center's Traumatic Brain Injury Clinic at Fort Gordon, Georgia. 74 active-duty service members with PTSD or anxiety disorder were divided into experimental and control groups with both receiving treatment as usual and the experimental group also receiving training in and practice of Transcendental Meditation (TM).  The experimental group receiving the extra TM training and practice were able to "reduce or even eliminate their psychotropic medication and get better control of their often-debilitating symptoms."

While I applaud their approach and the willingness of military personnel to undertake such timely research, I do have a few issues with their work.  First, it appears the control group did not receive an equal amount of extra staff attention and were not assigned a task that would also take an equal amount of time daily to do something akin to just sitting quietly for 20 minutes twice a day.  This was not a properly controlled study and does little to show anything special about TM.

Not that there isn't anything special about TM, it is just that this study design fails to show it. What David Lynch is doing with the Operation Warrior Wellness (OWW) program is highly commendable. Maharishi Mahesh Yogi's efforts to spread the practice of meditation globally should have won him the Nobel Peace Prize and his book Maharishi Mahesh Yogi on the Bhagavad-Gita : A New Translation and Commentary, Chapters 1-6 was a classic.  It is unfortunate he did not have time to translate the last 12 chapters. According to TM, the key is to 'be without the three gunas'. Being without the three gunas is, in essence, a state of non-judgemental mindfulness.

Still, I'm not convinced that TM has any special edge over other meditation techniques.  This is not a competition.  Comparing gurus is one step in the direction of cutting off someone's head because they do not believe what you believe. Just getting more people to meditate and quiet their sympathetic nervous system and default mode network would be a major step forward towards saving humanity from our possible path of self-destruction.

EMWave2

If these researchers want to be on the cutting edge of research in this field, there are at least two additional steps they can take. First they can supplement the effectiveness of participants meditation progress using heart rate variability biofeedback (HRV-b).  Having instant feedback on how you are progressing is extremely valuable. Increasing heart rate variability through biofeedback has been shown to improve the balance between the parasympathetic and sympathetic nervous system. There is a relatively inexpensive unit, the EMWave2 available from HeartMath that has been utilized in many studies to include some by the military.

My personal experience with the EMwave2 has been positive.  It's cost is not prohibitive ($200 dollars) although its durability can be improved.  My units tend to peter-out after about 1 year of fairly constant use. The best aspect of this form of non-intrusive biofeedback is its ability to keep you in a state of mindfulness.  When I find my mind wandering, the EMWave2 informs me which makes it a great adjunct to meditation.

I'm not sure if the EMWave2 uses a linear or non-linear algorithm to monitor heart rate variability (they will not divulge this information). The output it provides lets you know when the parasympathetic and sympathetic nervous systems are in balance and is referred to as coherence.

Vagus nerve in green

Electrical stimulation of the auricular branch of the vagus nerve has been shown to decrease sympathetic nerve activity, to increase vagal tone, and to activate the cholinergic anti-inflammatory pathway. The ear is the only place the vagus nerve is superficial and able to be stimulated non-invasively. The increase in vagal tone is achieved without the use of medication and is non-invasive. Decreasing systemic inflammation via the cholinergic anti-inflammatory pathway and increasing vagal tone have shown positive results for treating depression, chronic pain, PTSD, cancer, atrial fibrillation, stroke, heart failure, rheumatoid arthritis to mention a few. The cholinergic anti-inflammatory pathway is a recently described, vital part of the immune system who's role in various disease states is only recently being ascertained.

Vagus nerve stimulation
 with
TENS electrodes

Electrical stimulation of the auricular branch of the vagus nerve has great potential to play a key role in treating many diseases of modern society, it can modulate the default mode network, and that it can be manipulated without drugs is a big plus. What is so amazing is very few physicians have an interest in this process even though it involves a key part of our immune system.  I guess when some drug company comes out with a drug they can write a prescription for then they will start showing some interest.

DARPA, the Defense Advanced Research Project Agency, inventors of the internet (sorry Al Gore) and the premier agency for United States military research, has been funding research on vagus nerve stimulation to treat PTSD. From their website Work Begins to Support Self-Healing of Body and Mind:

"A team at the University of Texas, Dallas, led by Robert Rennaker and Michael Kilgard, will examine the use of vagal nerve stimulation to induce neural plasticity for the treatment of post-traumatic stress. As envisioned, stimulation could enhance learned behavioral responses that reduce fear and anxiety when presented with traumatic cues. Dr. Rennaker is a U.S. Marine Corps veteran who served in Liberia, Kuwait and Yugoslavia."

Not a recommendation but this product found on Amazon may serve the purpose of stimulating the auricular branch of the vagus nerve.

New article from Biological Psychiatry (Feb 2016) from Harvard, Medical College of Wisconsin, and China titled Transcutaneous Vagus Nerve Stimulation Modulates Default Mode Network in Major Depressive Disorder involves stimulation of the auricular branch of the vagus nerve to treat depression and demonstrates its effect on the default mode network.

There is new research involving activation of the locus coeruleus via transcutaneous vagus nerve stimulation and it role in prevention of Alzheimer's.  See details in the next post.